Report on Implementation, Use, and Sustainability of a Labor Epidural Service in Georgetown, Guyana.

BACKGROUND: The use of epidural analgesia for laboring women is generally unavailable at public hospitals in Guyana despite favorable utilization rates in private institutions. In 2014, a healthcare team completed a targeted mission aimed at neuraxial analgesia training of providers at the preeminent public hospital in Georgetown, Guyana. This study evaluates the impact of the training, including provider attitudes, use, and barriers. METHODS: A prospective, mixed methods study of all obstetric, nursing, and anesthesiology providers at Georgetown Public Hospital Corporation was completed. Quantitative assessment of the posttraining use of epidural analgesia at 2 and 6 months was documented. Provider surveys were distributed anonymously at 2 months posttraining. Targeted interviews were completed from a random sampling of providers at 6 months; qualitative analysis of interviews formulated the basis for reporting limitations and barriers. RESULTS: Providers surveyed included 7 anesthesia providers and 24 obstetrics providers. Respondents believed Guyanese women should be offered epidural analgesia (93%), epidurals could be performed safely (87%), and Guyana has the resources necessary for routine use (81%). In assessing epidural knowledge, anesthesia providers achieved 60% correct response rate compared to 84% among obstetrics providers. Nurse anesthetists placed 16 epidurals following training. However, placement ceased after 2 months. The largest barriers to placement were unavailable anesthesia staff (63%), lack of supplies (16%), and insufficient nursing staff to monitor patients with epidurals (11%). CONCLUSIONS: A 1-week mission achieved widespread Guyanese provider acceptance despite a lack of previous experience. However, barriers proved insurmountable to achieving a sustainable, independently functioning epidural analgesia program.

Management of cancer pain

Cancer remains a major worldwide health problem with an estimated nine million new cases occurring annually. The incidence is progressively increasing, especially in the Caribbean and Latin America. About one-half of all cancer patients and over 70-80% of those with advanced cancer experience moderate to severe pain. Several surveys have clearly shown that about 80-90% of patients can have their pain easily controlled with simple available resources. Yet sadly, pain is often under-estimated and under-treated, resulting in unnecessary suffering and a compromised quality of life. There are many obstacles to adequate cancer-pain relief (AU)

Postoperative analgesia: management of postoperative pain

The International Association for the Study of Pain (IASP) defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Postoperative pain is acute and usually self-limiting. Several recent clinical surveys have clearly shown that an unacceptably high proportion of patients continue to experience significant postoperative pain. This article aims to discuss the current management of postoperative pain, highlighting the deficiencies and suggesting feasible solutions. Practical considerations, with particular reference to the developing world are emphasized(AU)